Provider Demographics
NPI:1811035280
Name:SCIARRA, MICHAEL A (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:SCIARRA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 RIVER ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020
Mailing Address - Country:US
Mailing Address - Phone:201-969-2111
Mailing Address - Fax:201-969-8015
Practice Address - Street 1:968 RIVER ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020
Practice Address - Country:US
Practice Address - Phone:201-969-2111
Practice Address - Fax:201-969-8015
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06004900207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7163908Medicaid
NJ7163908Medicaid
NJ522283Medicare ID - Type Unspecified